Utah Admin. Code R539-1-8 - Medicaid Waiver Eligibility and Enrollment for the Limited Supports Waiver

Current through Bulletin 2022-07, April 1, 2022

(1) Matching federal funds may be available through a limited support waiver that provides an array of home and community-based services for a person with an intellectual disability or related condition, or brain injury.
(a) A person must meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.
(b) A person must meet a waiver level of care as determined by the division.
(2) As described in Section 62A-5-102, the division determines waiver enrollment.
(a) The division shall offer enrollment in order of time spent waiting.
(b) The division shall identify a person through:
(i) an adjusted critical needs score at or below the person's age group threshold; and
(ii) no immediate need for out-of-home residential support services.
(c) The adjusted critical need score equals the person's total critical need score minus the time spent waiting component.
(d) A person shall be enrolled in a limited support waiver only if the person's assessed need can be safely met within the individual budget limit.
(4) Pursuant to Rule R414-510, if the Department of Health determines that sufficient funding is available, an eligible individual may receive a waiver service by transitioning out of an ICF into a limited support waiver.
(5) Pursuant to Rule R414-502, the Department of Health may find a person who meets nursing facility level of care eligible for funding through a limited support waiver.
(6) Any person offered enrollment in a Medicaid waiver may choose not to participate. If an eligible person chooses not to participate in a waiver, the person shall receive only the state funded portion of their assessed need as described in Section R539-1-9.


Utah Admin. Code R539-1-8
Amended by Utah State Bulletin Number 2016-22, effective 10/25/2016 Amended by Utah State Bulletin Number 2017-22, effective 10/23/2017 Amended by Utah State Bulletin Number 2020-08, effective 4/8/2020 Amended by Utah State Bulletin Number 2020-22, effective 11/9/2020 Amended by Utah State Bulletin Number 2022-05, effective 2/22/2022

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